Vacina pneumocócica 23-valente (polissacarídica) para imunização da população de idosos (60 anos ou mais) contra a doença pneumocócica / 23-valent pneumococcal (polysaccharide) vaccine for immunization of the elderly population (60 years and older) against pneumococcal disease

INTRODUÇÃO: A doença pneumocócica (DP), causada pelo Streptococcus pneumoniae, também denominado de pneumococo, é uma condição de elevada incidência na população mundial e brasileira. Ela compreende uma gama de infecções em que se destacam a pneumonia adquirida na comunidade, otite média aguda, sinusite bacteriana e meningite bacteriana aguda. Sua manifestação mais grave ocorre nos quadros de infecção secundária de corrente sanguínea pelo pneumococo, em geral por uma pneumonia primária, e nas meningites, condições definidas como doença pneumocócica invasiva (DPI) e que apresentam elevado risco de óbito. A doença pneumocócica está entre as principais causas de internação no Brasil e também de óbito. Certas condições de base aumentam muito o risco de desenvolvimento de DP e DPI, bem como elevam sua letalidade, das quais se destaca a população idosa. A presença de comorbidades tais como doença pulmonar obstrutiva crônica, insuficiência cardíaca, asma, doença renal ou hepática crônica, diabete mélito e tabagismo, associados a redução do movimento mucociliar na mucosa respiratória e a imunossenescência tornam a população idosa muito vulnerável a DP e DPI. Além disso, é crescente a resistência bacteriana do pneumococo incrementando as taxas de mortalidade por esta condição. A prevenção da DP

Changes in Serotype Distribution and Antibiotic Resistance of Nasopharyngeal Isolates of Streptococcus pneumoniae from Children in Korea, after Optional Use of the 7-Valent Conjugate Vaccine

We investigated serotype distribution and antimicrobial resistance of pneumococcal carriage isolates from children after optional immunization with the 7-valent pneumococcal conjugate vaccine (PCV7) in Korea. From June 2009 to June 2010, 205 (16.5%) pneumococcal isolates were obtained from 1,243 nasopharyngeal aspirates of infants and children at Seoul National University Children's Hospital, Korea. Serotype was determined by Quellung reaction and antibiotic susceptibility was tested by E-test. The results were compared to previous studies done in the pre-PCV7 period. In this study, the most common serotypes were 6A (15.3%), 19A (14.7%), 19F (10.2%), 35B (7.3%), and 6D (5.6%). The proportion of PCV7 serotypes decreased from 61.9% to 23.8% (P < 0.001). The overall penicillin nonsusceptibility rate increased from 83.5% to 95.4% (P = 0.001). This study demonstrates the impact of optional PCV7 vaccination in Korea; the proportion of all PCV7 serotypes except 19F decreased while antimicrobial resistant serotypes 6A and 19A further increased.

Fundamentos de las recomendaciones uso de vacuna neumococica / Fundamentals of use of pneumococcal vaccine recommendations

A juicio de CAVEI la vacuna antineumocócica en sus versiones disponibles de múltiples antigenos en forma conjugada debería utilizarse en el Programa Nacional de Inmunizaciones. El CAVEI recomienda el uso de la vacuna antineumocócica conjugada para: los cohortes de niños nacido a contar de la aprobación oficial de estas recomendaciones. Utilizar la fórmula de 2 dosis sucesivas a los 2 y 4 meses, más una dosis de refuerzo, la tercera dosis entre los 12-15 meses de edad. No utilizar la fórmula de catch-up, es decir de aplicación masivas a los menores nacidos antes de la aprobación oficial de esta recomendación, pues ella no agrega un beneficio sustantivo.

Ineffectiveness for infants of immunization of mothers with pneumococcal capsular polysaccharide vaccine during pregnancy

Pneumococcal (Pnc) carriage is associated with pneumococcal diseases. Breast feeding and maternal vaccination may be a useful approach to prevent pneumococcal infection in young infants. We examined the risk of Pnc carriage by infants at six months of age after pneumococcal polysaccharide vaccination of pregnant women. We selected 139 pregnant woman. The woman were randomly allocated to receive 23-valent polysaccharide vaccines during pregnancy (Group 1) after pregnancy (Group 2) or not receive any vaccine (Group 3). Nasopharyngeal swabs were collected from the infants at three and six months of age. The infants were evaluated monthly during the first six months. We included 47 mothers in Group 1, 45 mothers in Group 2 and 47 mothers in Group 3. Forty-seven percent of the babies were exclusively breast fed until six months, 26 percent received both breast feeding and artificial feeding and 13 percent received only artificial feeding. Among those patients, 26 percent were colonized by Pnc at six months (12 from Group 1, 13 from Group 2, and 12 from Group 3). There was no significant difference in colonization between the three groups. Thirty percent of the children were colonized by a non-susceptible strain. We concluded that young infants (three months old) are already susceptible to pneumococcal carriage. Vaccination during pregnancy with a polysaccharide vaccine did not decrease Pnc colonization.

Deficiencia de anticuerpos con imnunoglobulinas IgA, IgG e IgM normales / Antibody deficiency with normal IgA, IgG and IgM inmunoglobulins

Objetivos: revisar la deficiencia de anticuerpos con inmunoglobulinas normales que se caracteriza por infecciones bacterianas recurrentes; ausencia o disminución de respuesta para la mayoría de los antígenos polisacáridos; niveles séricos normales o aun poco disminuidos o elevados de inmunoglobulinas y de subclases de IgG y producción de anticuerpos adecuada ante los antígenos proteicos (sarampión, rubéola, etc) en individuos mayores que 2 años. Métodos: revisión bibliográfica de 10 años por medio del sistema MEDLINE. Resultados: se revisaron 68 artículos y se escogieron 41 para ser incluidos en esta revisión. Conclusiones: estar alerta con los pacientes con infecciones de repetición, principalmente pacientes con infecciones neumocócicas y realizar la evaluación en laboratorio complementaria para un correcto diagnóstico de la enfermedad.

sICAM-1 intrathecal synthesis and release during the acute phase in children suffering from Coxsackie A9 and S. pneumoniae meningoencephalitis / Sintesis intratecal de sICAM-1 y liberación durante la fase aguda en niños con meningoencefalitis por Coxsackie A9 y S pneumoniae

The intercellular adhesion molecule is a transmembrane glycoprotein belonging to the immunoglobulin superfamily. Serum and cerebrospinal fluid (CSF) soluble intercellular adhesion molecule 1 (sICAM-1) from normal control children as well as from children with Guillain-Barré syndrome (GBS), with Coxsackie A9 virus meningoencephalitis and with Streptococcus pneumoniae meningoencephalitis were studied. sICAM-1 was quantified using an immunoenzimatic assay and albumin using the immunodiffusion technique in both biological fluids. Increased sICAM-1 values in CSF in patients with GBS correspond to an increase of the albumin CSF/serum quotient. In contrast, in inflammatory diseases like S. pneumoniae and Coxsackie A9 virus meningoencephalitis an increased brain-derived fraction was observed. In particular cases these values are 60-65 percent and 70-75 percent respectively. The results indicate an additional synthesis of sICAM-1 in subarachnoidal space during central nervous system (CNS) inflammatory process. An important role of sICAM-1 in the transmigration of different cell types into CSF during CNS inflammation in children with S. pneumoniae and Coxsackie A9 meningoencephalitis may be suggested.

La molécula de adhesión intercelular es una glicoproteína que pertenece a la superfamilia de las inmunoglobulinas. Se estudiaron los niveles de molécula de adhesión intercelular tipo 1 soluble (sICAM-1) en suero y líquido cefalorraquídeo (LCR) de niños con meningoencefalitis por Streptococcus pneumoniae y por Coxsackie A9 al igual que en niños con sindrome de Guillain-Barré (SGB). sICAM-1 fue cuantificado por ensayo inmunoenzimático y la albúmina por inmunodifusión en ambos líquidos biológicos. Los valores incrementados de sICAM-1 en LCR en los pacientes con GBS corresponden a valores aumentados de razón LCR/suero de albúmina. En contraste, en las enfermedades inflamatorias como las meningoencefalitis por S. pneumoniae y por Coxsackie A9 se observa un incremento en la fracción derivada del cerebro. En casos particulares los valores se incrementan hasta un 60-65 por ciento y 70-75 por ciento respectivamente. Los resultados indican una síntesis adicional de sICAM-1 en el espacio subaracnoideo durante el proceso inflamatorio del sistema nervioso central (SNC). Esto puede sugerir un importante papel del sICAM-1 en la transmigración de diferentes tipos celulares en el LCR durante la inflamación del SNC en niños con meningoencefalitis por S pneumoniae y coxsackie A9.

Deficiencia de anticuerpos con inmunoglobulinas normales: relato de casos / Antibody deficiency with normal immunoglobulins: report review

Objetivo. Relatar 9 casos de deficiencia de anticuerpos para gérmenes encapsulados (H. influenzae, S. pneumoniae, B. catarrhalis y N. miningitidis) con inmunoglobulinas normales. Métodos. Evaluación clínica observando los criterios de Fundación Jeffrey-Modell y Cruz Roja Americana para inmunodeficiencias primarias. Evaluación en laboratorio con la investigación de anticuerpos antineumococos. Resultados. Hubo en el grupo estudiado una predominancia de infecciones de vías aéreas superiores y otitis. Las traqueobronquitis y las neumonías fueron frecuentes y hubo un caso de meningitis neumocócica. En 3 pacientes se utilizaron antibióticos profilácticamente y uno de ellos necesitó gammaglobulina. Conclusiones. Llamamos la atención del pediatra sobre esta inmunodeficiencia primaria de anticuerpos, con inmunoglobulinas generlamente normales, que puede explicar el por qué de las infecciones de repetición. La evaluación complementaria para esta deficiencia es laboriosa y costosa, pero importante porque define el diagnóstico y la terapéutica que se utilizará.

Immunogenicity of a 23-valent pneumococcal polysaccharide vaccine in elderly residents of a long-term care facility

S. pneumoniae is a significant cause of community-acquired pneumonia in the elderly, and accounts for the majority of the pneumonia deaths among the elderly. We conducted this randomized double-blind study to evaluate the immune response to a 23-valent pneumococcal polysaccharide vaccine and the persistence of antibodies two years after the vaccination in an elderly population in Santiago, Chile. A total of 118 elderly nursing home residents received either the pneumococcal or a tetanus control vaccine. Serum samples were taken at enrolment, at two months, and at two years post-vaccination. Pre-vaccination anti-pneumococcal antibody geometric mean concentrations (GMC) were similar in both study groups, with increased levels of antibodies found only against serotype 14. The pneumococcal vaccine was highly immunogenic at 2 months, and titers remained high two years after the vaccination for the 10 serotypes studied in this elderly population. The results thus support the benefits of this pneumococcal vaccine in this elderly population who are at increased risk of invasive pneumococcal disease.

Vacunas para la prevención de enfermedades por streptococcus pneumoniae (S. pn) / Vaccines for the prevention of diseases by streptococcus pneumoniae (S. pn)

Las infecciones causadas por S.pn. son un importante problema de salud pública en la infancia en todo el mundo. Es la principal causa de infecciones respiratorias altas (otitis media, sinusitis), bajas (neumonía), bacteremia oculta y meningitis agudas. Adicionalmente, el problema de la creciente resistencia a antimicrobianos ha puesto una variable más al complejo escenario clínico. El estudio de la epidemiología de las infecciones por streptococcus pneumoniae resulta particularmente importante para conocer el real impacto de medidas de prevención a través de medidas sociales, uso de terapia antimicrobiana empírica y prevención a través de vacunas. En estos aspectos resultan particularmente importantes dos iniciativas en desarrollo: la vigilancia latinoamericana de los serotipos mas prevalentes en la región (Sistema Regional de Vigilancia para Vacunas, SIREVA)(8,9) y los estudios locales del Centro para Desarrollo de Vacunas (CVD-Chile) dirigido por la Dra. Rosanna Lagos Z. (1,2,3).

Response to polysaccharide antigens in patients with ataxia-telangiectasia

OBJECTIVE: To analyze the production of antibodies to polysaccharide antigens in patients with ataxia-telangiectasia.PATIENTS AND METHODS: We used the ELISA technique to measure the levels of IgG antibodies to serotypes 1, 3, 5, 6B, 9V and 14 of Streptococcus pneumoniae in 14 patients with ataxia-telangiectasia before and after immunization with 23-valent polysaccharide vaccine. Adequate response to individual polysaccharide can be defined as a postimmunization antibody titer equal to or greater than 1.3 µg/ml or as a minimum fourfold increase over the baseline (preimmunization) value. RESULTS: Six (43%) patients showed an absent response to all serotypes analyzed. Four patients showed adequate response to only one serotype, one patient to two serotypes, two patients to three serotypes and only one patient to four out of six serotypes analyzed. No patient had adequate response to all serotypes tested. Postimmunization pneumococcus IgG levels were higher than preimmunization levels to all serotypes analyzed, except for serotype 3. In spite of this, the mean postimmunization levels were lower than 1.3 µg/ml in all serotypes, except for serotype 14. Mean increment was less than four in all serotypes analyzed. CONCLUSION: Our results suggest that patients with ataxia-telangiectasia are at a high risk of having an impaired response to pneumococcus, which may be one of the causes of recurrent sinopulmonary infections in these patients.

Age- and cause-specific childhood mortality in Lombok, Indonesia, as a factor for determining the appropriateness of introducing Haemophilus influenzae type b and pneumococcal vaccines.

Using age and cause-specific childhood mortality in Lombok, Indonesia, as a factor for determining the appropriateness of introducing Haemophilus influenzae type b (Hib) and pneumococcal vaccines, the study describes a cross-sectional, hamlet-level mortality survey in 40 of 305 villages in Lombok Island, Indonesia. Causes of death were assessed with a standardized verbal-autopsy questionnaire. One thousand four hundred ninety-nine births and 141 deaths occurring among children aged less than 2 years were identified, with 43% of deaths occurring during the first 2 months of life. The infant mortality rate was 89 (95% CI: 75, 104) per 1,000 live-births. All mortality rates are reported per 1,000 live-births. To examine children whose deaths could potentially have been prevented through vaccination with Hib or pneumococcal vaccine, deaths due to acute respiratory infection (ARI) and central nervous system (CNS) infections among children, aged 2-23 months, were analyzed. ARI and CNS infections caused 58% (mortality rate: 31 per 1,000 live-births; 95% CI: 23, 41) and 17% (mortality rate: 9 per 1,000 live-births; 95% CI: 5, 16), respectively, of all deaths within this age group. Between the ages of 2 and 23 months, 5% of all babies born alive died of ARI, and another 1% died of CNS infections. Our results indicate that current efforts to reduce childhood mortality should focus on reducing ARI and meningitis. These efforts should include evaluating the impact of Hib and pneumococcal vaccines within the routine Expanded Programme on Immunization system.

Evaluation of antibody responses to pneumococcal vaccines with ELISA and opsonophagocytic assay

Antibodies to a capsular polysaccharide (PS) provide protection against Streptococcus pneumoniae which express the homologous capsular serotype, and pneumococcal vaccines are designed to induce antibodies in the capsular PS. Levels and opsonophagocytic capacity of antibodies to the capsular PS of S. pneumoniae serotype 19F were determined by sera from adults immunized with 23-valent S. pneumoniae capsular PS vaccines. Geometric means of IgG anti-19F antibody level and specific opsonic titer rise significantly after immunization. The level of anticapsular PS antibodies for S. pneumoniae 19F serotype is fairly well correlated (r2=O.63) with the opsonophagocytic activities of sera. However, 3.7% (1/27) of serum samples display strikingly less opsonophagocytic activity than expected on the basis of their antibody level. Thus, antibody level may be of general use in predicting vaccine-induced protection among adults for 19F serotype. However, the opsonic activity data suggest that antibody levels are not always indicative of functional antibody.

Avaliaçäo da produçäo de anticorpos ao Streptococcus pneumoniae em pacientes com infecçöes de repetiçäo / Assessment of antibody levels against Streptococcus pneumoniae in patients with current infections

Objetivos: Revisao bibliográfica relativa à avaliaçao funcional de anticorpos ao pneumococo como meio de aprofundamento da investigaçao imunológica de pacientes com infecçao de repetiçao. Métodos: O radioimunoensaio e o ensaio imunoenzimático sao utilizados para dosagem de anticorpos a alguns sorotipos de Streptococcus pneumoniae, antes e depois de imunizaçao específica. Resultados: Os critérios de interpretaçao dos resultados deste exame diferem entre os diversos grupos de pesquisadores. Conclusao: A avaliaçao da produçao de anticorpos ao pneumococo é útil no diagnóstico de "Deficiência de anticorpos específicos".

Inmunización y respuesta inmune a la vacuna neumocócica / Immunization and immune response to neumococcal vaccine

The aim of this work was to define antibody levels against four neumococcal serotypes, before and after neumococcal vaccination in patients with respiratory infections. Fifty one patients were studied, 19 children from 1 to 5 yeras old, 19 children from 6 to 18 years old and 22 adults from 27 to 65 years old. IgG anti-neumococcal, antibodies, against serotypes 3, 7F, 9N and 14 were measured using an enzyme immunoassay, before and four weeks after vaccination. There was a significant increase in antibody titers against all serotypes in subjects older 7 yeras. In children of less than 6 yeras, the response to serotype 14 was non significant. The intensity of response differed according to the studied serotypes and the percentage of patients that responded to each serotype increased with age. Five patients older than 18 years were identified as non responders to all four serotypes. It is concluded that neumococcal vaccine increases anti-neumococcal antibodies in patients with recurrent infections and allows the identification of patients with specific antibody deficiency syndromes and normal total immunoglobulin levels

Polyvalent pneumococcal polysaccharide vaccines: a review of literature

Streptococcus pneumoniae e um agente bacteriano responsavel por uma grande incidencia de morbidade e mortalidade em criancas e em idosos e tambem em individuos portadores do virus da imunodeficiencia humana (HIV). S. pneumoniae tem sido um agente bacteriano isolado com grande frequencia em pneumonias, otite media, sinusite, bacteremia e meningite. A vacina polivalente pneumococica contem os polissacarides capsulares dos 23 sorotipos de S. pneumoniae mais frequentemente encontrados como causadores de infeccoes pneumococicas em diversos paises. Public Health Service Advisory Committee on Imunization Pratice, pertencente ao Centers for Disease Control (CDC), nao recomenda o emprego da vacina pneumococica para a imunizacao da populacao em geral. Contudo, diversos pesquisadores tem recomendado seu emprego para populacoes especiais como por exemplo, os portadores de infeccao por HIV, que estao sujeitos a um alto risco de infeccoes pneumococicas sistemicas. A presente revisao da literatura tem como objetivo divulgar a importancia da vacina polivalente pneumococica bem como suas propriedades imunologicas e seus efeitos na populacao vacinada.